摘要
目的探讨骨外固定动力化对开放性胫腓骨骨折愈合的影响。方法回顾分析2016年2月—2017年2月采用骨外固定治疗的胫腓骨开放性骨折患者临床资料,根据术后处理方法不同分为弹性动力化组(A组)和恒弹性固定组(B组),每组13例。两组患者性别、年龄、骨折分型等一般资料比较差异均无统计学意义(P>0.05),具有可比性。B组患者术后按传统方法,根据骨折愈合时间、X线片等影像学检查及临床医师经验评价骨折愈合程度,骨折达到临床愈合时拆除外固定架;A组术后12周开始根据X线片检查骨痂生长情况,对患者进行轴向力学载荷比测试,轴向力学载荷比为5%~10%时进行动力化处理。比较两组患者外固定架使用时间、骨折愈合时间及并发症发生率。结果两组患者均获随访,随访时间4~13个月,平均5.7个月。治疗期间两组均未发生外固定架松动、断裂及骨折移位、再骨折等并发症。A组外固定架使用时间为(24.77±1.42)周,骨折愈合时间为(23.04±1.30)周,与B组的(34.38±1.71)周和(32.46±1.66)周比较均显著减少(t=16.10,P=0.00;t=15.58,P=0.00)。A组术后发生针道感染2例、肌力减退1例,并发症发生率为23.1%;B组发生针道感染3例、肌力减退1例及骨折延迟愈合1例,并发症发生率为38.5%;两组并发症发生率比较差异无统计学意义(P=1.000)。结论骨外固定动力化能够加速骨折愈合,且安全性较高。
Objective To evaluate the effects ofdynamization of external fixation on open tibia and fibula fracture union. Methods The clinical data of 26 cases of open tibia and fibula fractures treated by external fixation were retrospectively analysed. According to different postoperative treatment methods, the patients were divided into elastic dynamic group （group A, n=13） and constant elastic fixation group （group B, n=13）. There was no significant difference in gender, age, and fracture type between 2 groups （P〉0.05）. The removal time of external ftxator in group B was evaluated by fracture healing time, X-ray film, and doctor＇s experience. In group A, the growth of callus was examined based on X-ray film at 12 weeks after operation; the axial mechanical load ratio was tested, and dynamic loading was carried out when the axial mechanical load ratio was 5%-10%. The using time of external flxator, fracture healing time, and incidence of complications were compared between 2 groups. Results All patients were followed up 4-13 months, with an average of 5.7 months. During the treatment, there was no complication such as loosening or breaking of the external fixator, fracture displacement, or re-fracture in 2 groups. The using time of external fixator in group A was （24.77±1.42） weeks and the fracture healing time was （23.04±1.30） weeks, which were all significantly reduced when compared with those in group B [（34.38±1.71） weeks and （32.46±1.66） weeks] （t=16.10, P=0.00; t=15.58, P=0.00）. In group A,there were 2 cases of needle tract infection and 1 case of muscle weakness, the incidence of complication was 23.1%; in group B, there were 3 cases of needle tract infection, 1 case of muscle weakness, and 1 case of delayed union of fracture, the incidence of complication was 38.5%; there was no significant difference in the incidence of complication between 2 groups （P=1.000）. Conclusion Dynamization of external fixation can promote union of open tibia and fibula fractures with a high security.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第2期174-177,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
天津市卫生局科技基金资助项目(13KG129)~~
关键词
开放性胫腓骨骨折
动力化
轴向力学
外固定
Open tibia and fibula fractures
dynamization
axial mechanical determination
external fixation
